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Massive weight loss is a huge
decision, most of you reading have either gone through a massive weight
loss or are contemplating going through a massive weight loss. One of
the most common hesitations in losing weight is the resulting loose skin
that occurs once your body has gone through a significant weight loss.
It is common knowledge that losing weight = loose skin.

Loose skin not
only occurs with a massive weight loss but also with natural body
occurrences such as pregnancy. This is because once your body stretches
through weight gain or through pregnancy; your skin loses its
elasticity. First patients come in to talk about weight-loss and
bariatric surgery, how it works and your results. Many patients,
however, decide they want to go the less expensive and natural way by
strict diet and exercise but are concerned about the loose skin.

Our
doctors always tell patients to be realistic, being healthy is far more
important than having loose skin.

Even when you have loose skin after
weight loss there are ways to remove it such as post-bariatric surgery
which includes tummy tucks, breast augmentations, and thigh lifts. The
loose skin, although it may not seem like it, is a proud reminder of how
far you've come and if you take that extra step to remove the loose
skin, your body will be an entire trophy dedicated to yourself. In this
post, we will see why and where that extra skin came from and how to
reduce or remove it.

How We Burn Fat

As we all know, matter
cannot be created nor destroyed, so when you exercise and diet fat is
not simply "disappearing" off your body. What occurs is a form change,
just like water and steam. The glucose and sugar that is harnessed from
carbohydrates are the first fuel sources. Once the glucose runs out, fat
takes over. Your body is a constant interconnected conveyor belt that
removes essential nutrients from the fat and delivers them to specific
body parts. Hormones that regulate our blood sugar levels activate an
enzyme in fat tissue called lipase. Lipase ignites fat cells to release
triglycerides, which is what makes fat cells fat. When they receive a
signal from lipase to exit the fat cells, the triglycerides break-up
into glycerol and fatty acids and then enter the bloodstream for use in
your body. The process of breaking down triglycerides into reusable
energy is called lipolysis which is shuffled and reshuffled to produce
heat, water, carbon dioxide, and ATP. Since the fat tissue has lost some
of its components, the cells shrink.

Why the Extra Skin?

When
fat tissue is worked and the cells shrink, wouldn't it make sense that
your skin would shrink as well?

Yes and no. In the cases of moderate
weight loss, skin can certainly shrink back to fit the body's new size
because of its elasticity due to collagen in the skin. However, collagen
does have its limits. Collagen fibers weaken with age and results in
wrinkles. Rapid growth or weight gain also outpaces collagen production
in the skin causing areas to over-stretch, leading to stretch marks
commonly seen in pregnancy and adolescents going through puberty. In
cases of massive weight-loss, the skin that has been stretched has lost
its collagen strength making it very difficult if not impossible for the
extra skin to shrink back to its former shape. Those undergoing gastric
bypass surgery or bariatric surgery feel this pain. As the number of
patients going through weight loss surgery increases, so do corrective
surgeries for the unwanted and uncomfortable skin. This extra skin can
actually be a serious problem and can actually cause infections, rashes
and even back problems.

Post-Bariatric Surgery and Treatment Options

The
most important determinant of how much loose skin an individual will
have following weight loss is their age. Younger patients tend to have
less loose skin than those who are older because of the strength of
collagen in your skin. The next most important factor is the amount of
weight loss. An individual who loses 200 lbs. is more likely to have
excess skin than someone who has lost 80 lbs. There are other factors of
who is more likely to have loose skin such as smoking, sun damage and
skin color.

- Exercise: Exercise that includes increasing muscle
town can tighten connective tissue. For patients who have undergone
bariatric surgery are recommended to add a regular exercise regimen that
is helpful to maintain ones weight and can also serve to tighten loose skin to some extent.

- Body Contouring Procedures: For those that
are losing 80 lbs. to over 100 lbs. surgical procedures, known as
post-bariatric surgery, are available to tighten skin and remove the
extra pockets of skin that inhibit your body from being as toned and
tight as the individual would like. Below are the most common procedures
for massive weight loss patients.

Abdomen, Thighs and Buttocks-
The abdomen is usually one of the greatest concerns for individuals
following massive weight loss. In both men and women, excess fat is
stored both in the abdomen and beneath the skin of the abdominal wall.
Consequently following weight loss in those areas, extra skin appears.
Large amounts of hanging skin can lead to the collection of moisture
between the skin folds resulting in a condition called intertriginous
dermatitis, which leads to irritation, redness and pain. Occasionally,
the skin may even breakdown, bleed and become infected. With proper
documentation, many insurance companies recognize this problem and
provide full coverage from surgical removal through a tummy tuck or
abdominoplasty.

The abdominoplasty will solely remove the excess skin
from your stomach which is ideal for women following pregnancy. However,
for those who have undergone weight loss surgery or a massive weight
loss, excess skin is not limited to the stomach but also results in the
buttocks and thighs. Because of this, surgeons will perform a procedure
specifically for weight-loss patients called a body lift. This involves
an abdominoplasty, thigh and buttock lift all at one time. This
addresses and removes loose skin and cellulite along the thighs and
buttocks as well as the abdomen. Although the resulting scar is lengthy,
it is confined to the waistline and is hidden by underwear, panties, or
a bikini.

Breasts- Following a great weight loss, breast size and
shape often change significantly in both men and women. Everyone
worries about sagging breasts as we age but few know that massive weight
loss greatly accelerates the process. As women advance from girls to
teens to twenties and into their later years, the glandular portion of
breasts is replaced by fat. The original glandular tissue is
significantly more firm than fat and consequently the skin becomes
unable to retract completely and produces severely ptotic or sagging
breasts. This is called breast involution. There are many treatment
options for women following weight loss.

If a woman desires less sagging
and wants to be larger, a breast lift or mastopexy is needed. Again,
surgeons will tell you your options and also remind you to be realistic
with or breast augmentation may be satisfactory. The problems in men are
similar however treatment is slightly different. Men tend to have
larger breasts when over-weight. Depending on a man's age, degree of
weight loss, and a few other factors he may result in large breasts,
large and/or sagging breasts, or satisfactory breasts following weight
loss. Large and/or sagging breasts in men is called gynecomastia. Here
liposuction alone may be satisfactory, however this is not typical.

Most
men with both sagging and large breasts go through a two-staged
procedure. The first stage is liposuction and is performed to remove
excess fat and some glandular tissue. Over the next few months, the
breast skin will retract slightly. Three to six months later, the
patient will return to evaluate the situation and determine if the
outcome is satisfactory. Delaying the second stage allows for
significant skin retraction and if a skin tightening procedure is
desired it is likely to require smaller incisions.

The Bottom Line?

Being
healthy has far greater importance than excess skin. Although, having
excess skin can lead to some serious issues there are non-surgical ways
of preventing infections such as keeping your excess skin dry. For those
who are able and want to remove the excess skin, post-bariatric surgery
is for you. It is important to remember that these procedures should
only be considered after ones weight has stabilized; especially after
weight loss surgery. This can range from 7-18 months after weight loss.
The most important factor in finding a plastic surgeon who can perform
these procedures is that they must be board certified. If your plastic
surgeon's website or office does not advertise that they are board
certified you must RUN! For everyone who has heard horror plastic
surgery stories, this is probably where it started, having a surgical
procedure done without a board certified surgeon. Use ASPS (The American
Society of Plastic Surgery) to find a board certified surgeon near you.

Luna Plastic Surgery in Atlanta provides expert knowledge and
information for their patients. Directed towards patient care, Luna
Plastic Surgery specializes in post-bariatric surgery and tummy tucks.
They are committed to compassionate care, excellent results and patient
safety. Luna Plastic Surgery aims to provide the best aesthetic and
functional results under a warm personal interaction. We are proud to
offer our patients the kind of changes that will improve patients'
self-esteem without ever compromising their natural appearance.